How can I get hormones without a diagnosis?

In the UK, there are a number of different ways you can access hormone therapy:

• using an NHS gender service
• using a private gender service
• using a gender service outside the UK
• bridging prescriptions
• self-medicating

For the last three options you don’t need a formal diagnosis, but you should consider the pros and cons of each approach carefully. You can read more about your options on this page.

Using a gender service outside of the UK

You may opt to access HRT services outside the UK. Here are some pros and cons of choosing an overseas service:

In the UK, many people looking for an overseas service use GenderGP.

Services outside the UK may give you a prescription written by a doctor in the EU. Some UK pharmacies may refuse to accept these, even though a prescription being from the EU rather than the UK does not make the prescription invalid. If you experience problems with your pharmacy, you may wish to show them the information about filling an EU prescription on the GOV.UK website and the Royal Pharmaceutical Society website, or ask local groups for recommendations for pharmacies to use.

Bridging prescriptions

A bridging prescription provides temporary HRT from your GP while you wait for a diagnosis.

Waiting lists for NHS services are notoriously long, and you might be able to convince your GP that it’s unreasonable to expect you to wait that long for hormones 1, p.25. However, current GMC guidance is for GPs to prescribe bridging prescriptions only when a patient is already self-medicating, or is likely to start self-medicating, and is at risk of self-harm or suicide 2. The guidelines also suggest providing only the minimum dose 2, which some GPs interpret as being the smallest possible dose, rather than the smallest effective dose. If your GP is uncertain about providing a bridging prescription, you can suggest they speak to their local NHS gender service for advice.

Members of the UK trans community have created a guide to asking for a bridging prescription that you can download:

• How to Self-Advocate for a Bridging Prescription
• How to Self-Advocate for a Bridging Prescription (easy read version)

You can find more information about bridging prescriptions in this booklet by The Love Tank CIC and on the TransActual website.

Self-medicating

Self-medicating means buying hormones directly yourself without a prescription.

Unmonitored hormone therapy carries several risks. If you’re already taking hormones from another source, your GP should strongly consider providing a bridging prescription and monitoring blood tests 1, p.21. You may have to convince them that without safe access to medication you will be at a greater risk of self-harm or suicide 2.

Regardless of where you get your hormones, regular blood tests are essential to ensure your hormone levels are safe and that there are no problems. You can read more about blood tests on our blood testing page. If your GP is unable or unwilling to give you blood tests at the practice, read our page on dealing with common problems for more suggestions.

As testosterone is illegal to import into or sell in the UK, it can only be purchased on the “grey market” from vendors who are willing to break the law. Giving testosterone to someone else - even for free - can also have serious legal consequences including time in prison.

If you are injecting medications yourself, read our self-injections page for information about safety, obtaining injection supplies, and correct disposal of waste.

Many medications sold online do not contain any active ingredients and are a waste of your money. Even if the medications are genuine, their safety and purity are not guaranteed unless you have bought them from a legitimate pharmacy.

Finally, it is important to note that if you are self medicating, your access to hormones may be affected in the event that you are admitted as an inpatient at a hospital or psychiatric facility.

How do I talk to my GP?

When talking to your GP, the following references may be useful:

• The NHS England service specification 3, p.30 states:

  Endocrine and other pharmacological interventions may be recommended by a registered medical practitioner in the specialist multi-disciplinary team where they are essential for the purpose of harm reduction, and where they are in the individual’s best interest for reducing gender dysphoria, when assisting the individual in achieving gender expression congruent with their identity and consistent with their treatment goals.

• The NGICNS Explanatory Notes to the Scottish gender protocol 4, p.5 states:

  Some service users may already be on hormonal treatment prior to referral, either through previous prescription or self medication. It is appropriate to continue this treatment following engagement with the GIC whilst Assessment One is undertaken. Appropriate prescribing guidelines and monitoring requirements are detailed in Endocrine Management of Adult Transgender Service users (NGICNS) and all service users should be made aware of this guidance and prescribing and monitoring of treatment brought in line with this guidance.

Some GPs are hesitant to prescribe hormones as they are unfamiliar with standard HRT treatments for trans people. However, they will be familiar with the same medications used for other purposes, such as treating hypogonadism, hormone-sensitive cancers, or menopausal symptoms; the GMC 5 notes that

Most of the medications used for the treatment of gender dysphoria are not licensed for this specific indication, although GPs will be familiar with their use in primary care for other purposes.

A number of gender clinics have published prescribing guidelines that your GP may find useful; you can find a list of these in the Hormones section on genderarchive.org.uk.

References

1. 1.
   Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link
2. 2.
   General Medical Council (2020) “Trans healthcare: Mental Health and Bridging Prescriptions.” Link (Accessed 19th October 2020)
3. 3.
   NHS England (2019) Service specification: Gender Identity Services for Adults (Non-Surgical Interventions), NHS England. Link
4. 4.
   National Gender Identity Clinic Network Scotland (2012) Explanatory Notes v1.0: To be read in conjunction with the Gender Reassignment Protocol CEL 26 (2012), NHS Scotland. Link
5. 5.
   General Medical Council (2020) “Trans healthcare: Prescribing.” Link (Accessed 19th October 2020)

Errors and omissions

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